The recent tragedies in our nation's schools shocked and saddened all Americans, and remind us of the complexity and frailty of the human mind. Although these acts demonstrate extreme outward expressions of distress, undiagnosed and untreated mental illness pose a real and constant threat to our everyday lives. Could these deaths have been prevented?
According to the National Institute of Mental Health, an estimated 26.2% of Americans 18 years of age and older (one in four adults) suffer from a diagnosable mental disorder in a given year. This figure, when applied to the 2004 U. S. Census residential population, translates into 57.7 million people. Of these, however, only 6% suffer a serious mental illness. The capacity of our current healthcare system to provide mental health services and the identified need for such services are grossly disproportionate; the number of qualified mental health professionals is too few for the number of persons seeking care. Access to mental health services is sparse, restricted, or nonexistent in some areas and for certain populations, especially the poor and uninsured. This reality creates seemingly overwhelming challenges for an already strained mental healthcare system. Thus, part of the burden and responsibility to provide mental health services falls on primary care providers, including nurse practitioners (NPs).
Part of Your Differential
The 18th goal of Healthy People 2010 is to "improve mental health and ensure access to appropriate, quality mental health services," with one objective: to "increase the number of persons seen in primary care who receive mental health screening and assessment." Nurse practitioners in outpatient settings are often the entry point to all healthcare services for individuals and also their only access to any type of healthcare. Patients present with physical and emotional complaints. During a thorough assessment, the NP will query patients not only about physical health but also about satisfaction with work, school, family, and other relationships; life stressors and coping strategies; and overall satisfaction with present life situations. A patient may make a bold or a subtle statement that triggers concerns or the patient may exhibit nonverbal behaviors characteristic of a mental disorder. These red flags provide excellent opportunities to screen for mental illness.
If a mental disorder is diagnosed, you can offer intervention and treatment, further testing, and/or referral. Including mental illness in your differential diagnoses (even if in the back of your mind) will help identify undiagnosed mental illness. There are numerous easy-to-administer short surveys available to use in screening for common mental health disorders seen in primary care, such as depression and anxiety. More advanced common problems and complex psychiatric disorders may warrant the expertise of a specialist, such as a psychiatric NP, for accurate and timely diagnosis and appropriate intervention.
NPs are Key
Mental health is necessary for overall well-being, to establish and sustain interpersonal relationships, and to promote individual productivity in the community and society. Many of the mentally ill do not know they are suffering from a treatable disorder. Nurse practitioners can help these individuals recognize their illness and receive appropriate treatment to improve their quality of life. Undiagnosed and untreated mental illness destroys individuals and affects many beyond the individual. The goal is to improve the quality of life for individuals with mental illness through increased screening efforts in primary care, earlier diagnosis, and intervention. None of this will happen without access. Fortunately, NPs are providers that ensure greater access to many.
Jamesetta Newland, PhD, APRN, BC, FNP, FAANP, FNAP
Editor-in-Chief